Multi-Ligament Knee Reconstruction
Cruciate and collateral ligaments limit front-to-back, side-to-side, and rotational motion of the knee. Chronic instability caused by a multiple-ligament knee injury often requires surgery. In some cases, a knee ligament can be repaired by reattaching the ligament to the bone with sutures or staples. In other cases, a reconstruction operation is necessary which involves replacing or reinforcing the loose ligament with a tendon graft.
An isolated injury or partial tear to the ligament, such as grade 1 or grade 2 injury, can usually be treated without surgery or with a ligament tightening. However, if other structures in the knee are injured, or if the tear is considered a grade 3 injury, surgery to reconstruct the knee ligament may be required.
Knee Ligament Repair
In a repair procedure, your orthopedic surgeon may determine that the torn knee ligament can be reattached. This is usually done by finding the exact anatomic spot of the normal ligament attachment on the bone and reattaching the damaged ligament with special sutures, screws, or staples. When a ligament is ruptured, however, it often needs to be reconstructed, which means replacing the ligament with other tissue.
Knee Ligament Reconstruction
There are two methods used for a knee ligament reconstruction in cases of a grade 3 injury: autograft and allograft reconstruction. Typically, tunnels or sockets are drilled into the bone which allows your surgeon to weave the autograft or allograft tissue into the tunnels. The autograft or allograft tissues are held in place by screws or anchors thereby creating or reconstructing new ligaments.
If a tendon graft is needed to replace a loose knee ligament, it is usually taken from somewhere else around the same knee. Taking tissue from your own body is called an autograft. Common autografts include hamstring tendons, patella tendon, and quadricep tendon. Studies have shown that these tendons can be removed without significantly affecting the overall strength or function of the leg.
Another way to replace a badly torn ligament is with an allograft. For this procedure, the surgeon gets graft tissue from a tissue bank. This tissue is usually removed from an organ donor at the time of death and sent to a tissue bank. There the tissue is checked for infection, sterilized, and stored in a freezer. When needed, the tissue is ordered by the surgeon and used to replace the torn ligament.
After knee surgery, you will meet with the SROSM physical therapy team to begin your rehabilitation program, which could include standard physical therapy and/or aquatic therapy. Rehabilitation starts out slowly and treatments will vary depending on the type of surgical procedure that was used. The Sterling Ridge Orthopaedics & Sports Medicine offices in The Woodlands and Spring have some of the most advanced rehabilitation equipment and techniques available.
The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. You will be required to use crutches and wear a knee brace for 6 to 8 weeks. There are many goals of physical therapy, which include protecting the post-surgical knee, reducing inflammation and pain, and restoring strength, proprioception (body’s sense of positioning), and the natural range of motion. It is important to follow the recommendations of your physical therapy team, especially if you have certain restrictions or limitations.
In most cases, patients will be able to resume their previous lifestyle activities. Depending on the speed of recovery, however, some patients may be encouraged to modify their activity choices until the doctor feels as though they are ready.
To speak with an SROSM knee specialist, make an appointment at the location closest to you. You can also learn more about multi-ligament knee injuries by downloading our educational documents A Patient's Guide to Collateral Ligament Injuries.